#3871 of 11K

J1096

HCPCS Procedure Code

HCPCS code J1096 is the #3,871 most-billed Medicaid procedure code, with $1.1M in payments across 6K claims from 2018–2024. The national median cost per claim is $169.03.

Total Paid

$1.1M

0.00% of all spending

Total Claims

Providers

Avg Cost/Claim

$167

National Cost Distribution

How much do providers bill per claim for J1096? Based on 22 providers billing this code nationally.

Median

$169.03

Average

$139.81

Std Dev

$95.62

Max

$261.71

Percentile Distribution (Cost per Claim)

p10

$17.37

p25

$41.33

Median

$169.03

p75

$228.28

p90

$238.00

p95

$246.20

p99

$258.54

50% of providers bill between $41.33 and $228.28 per claim for this code.

90% bill between $17.37 and $238.00.

Top 1% bill above $258.54.

About This Procedure

HCPCS code J1096 was billed by 24 providers across 6K claims, totaling $1.1M in Medicaid payments from 2018–2024. This code was used for 5K unique beneficiaries.

Fraud Risk Context

Injectable drug codes carry high per-claim costs and have been involved in drug diversion and upcoding schemes.

Source: HHS OIG Reports

Risk Assessment

Billing Statistics

Median Cost/Claim

$169.03

Providers Billing

National Spending

$1.1M

Avg/Median Ratio

0.83×

Normal distribution

Top Providers Billing This Code

Ranked by total Medicaid payments for J1096

#	Provider	Total Paid	Cost/Claim	vs Median	Tier
1	1104199413	$206K	$217.31	1.3× median	Above Median
2	1538432844	$189K	$228.55	1.4× median	Above 75th
3	1306119615	$135K	$231.21	1.4× median	Above 75th
4	1376115816	$112K	$188.63	1.1× median	Above Median
5	1558305086	$107K	$246.63	1.5× median	Top 10%
6	1407120512	$75K	$200.53	1.2× median	Above Median
7	1194492546	$59K	$216.47	1.3× median	Above Median
8	1821361130	$44K	$238.14	1.4× median	Top 10%
9	1861089666	$42K	$261.71	1.5× median	Top 1%
10	1487657862	$35K	$51.61	0.3× median	Below Median
11	1700828423	$18K	$236.70	1.4× median	Above 75th
12	1205454626	$13K	$23.07	0.1× median	Below Median
13	1275569121	$10K	$227.45	1.3× median	Above Median
14	1164472031	$5K	$74.47	0.4× median	Below Median
15	1902834922	$4K	$149.43	0.9× median	Below Median
16	1194214510	$3K	$16.83	0.1× median	Below Median
17	1114091501	$2K	$89.32	0.5× median	Below Median
18	1851317861	$1K	$106.58	0.6× median	Below Median
19	1962446385	$827	$5.17	0.0× median	Below Median
20	1023005139	$720	$37.91	0.2× median	Below Median

Showing top 20 of 24 providers billing this code

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J1100$58.7M J1095$1.5M J1097$791K J1094$66K J1105$915

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